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Abstract #6546 Published in IGR 3-2
Results of viscoanalostomy for primary open-angle glaucoma
Sunaric-Mégevand G; Leuenberger PMAmerican Journal of Ophthalmology 2001; 132: 221-228
PURPOSE: Viscocanalostomy (VCS) is a nonperforating filtering surgical procedure that may avoid postoperative complications common with standard trabeculectomy. This study was conducted to determine the surgical outcome of this procedure after a postoperative observation period of 12-36 months. METHODS: An interventional consecutive case series. In a prospective study, a consecutive series of 67 eyes of 67 patients with chronic primary open-angle glaucoma underwent VCS. Patients with angle-closure glaucoma, post-traumatic, uveitic, neovascular, or dysgenetic glaucoma were excluded, as well as those who needed combined cataract-glaucoma procedures. The patients were examined postoperatively on the first day, at the first week, and at one month, and then at three-month intervals through 36 months. At each visit, best-corrected visual acuity, intraocular pressure (IOP), and the appearance of the surgical wound, anterior chamber, and indirect funduscopy, were recorded. RESULTS: Complete success was defined as an IOP of less than or equal to 20 mmHg and greater than or equal to 30% IOP reduction without medical or additional surgical treatment, compared with the IOP from a preoperative level, with maximum tolerated medical therapy; qualified success an IOP of less than or equal to 20 mmHg with treatment, or an IOP reduction of less than 30% from the preoperative level with maximum tolerated medical therapy; qualified failure an IOP greater than 20 mmHg with glaucoma medication, but no optic nerve or visual field deterioration; and complete failure an eye requiring further glaucoma surgery or lost visual function. The overall success rate was 88% at one year, 90% at two years, and 88% at three years, with a complete success of 68% at one year, 60% at two years and 59% at three years. Four eyes had perforation of Descement's membrane, three of which needed peripheral iridectomy; six eyes had a microperforation not needing peripheral iridectomy. Five eyes presented with hyphema. Eight eyes presented with deterioration of visual function after surgery: three because of corneal astigmatism, one because of cataract, and four presenting with glaucomatous deterioration of the visual field despite pressures of under 20 mmHg. Four eyes had progressive cataract formation judged to be independent of surgery. CONCLUSIONS: VCS provided an overall success rate of 88% and a complete success rate of 59% three years after surgery. The major immediate complication is perforation of Descemet's membrane with a need for peripheral iridectomy. No serious long-term complications were noted in this small series. Visual function remained stable in 55 eyes (82%).
Dr G. Sunaric-Mégevand, Division of Ophthalmology, Department of Neuroscience, University Hospital Geneva, 22 Rue Alcide Jentzer, 1205 Geneva, Switzerland
Classification:
12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
